| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,100 |
1,340 |
$230K |
| D9248 |
|
1,405 |
1,360 |
$117K |
| D1120 |
Prophylaxis - child |
2,738 |
2,738 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
3,842 |
3,842 |
$97K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,842 |
2,768 |
$93K |
| D1110 |
Prophylaxis - adult |
1,745 |
1,745 |
$90K |
| D7140 |
Extraction, erupted tooth or exposed root |
626 |
413 |
$87K |
| D1206 |
Topical application of fluoride varnish |
4,422 |
4,422 |
$77K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
665 |
519 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
4,712 |
4,699 |
$64K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
435 |
264 |
$61K |
| D0274 |
Bitewings - four radiographic images |
1,698 |
1,698 |
$50K |
| D0272 |
Bitewings - two radiographic images |
2,308 |
2,308 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,664 |
2,647 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
201 |
155 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
568 |
568 |
$25K |
| D0330 |
Panoramic radiographic image |
444 |
444 |
$24K |
| D1351 |
Sealant - per tooth |
783 |
246 |
$24K |
| D2330 |
|
100 |
67 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
177 |
175 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
94 |
94 |
$6K |
| D2331 |
|
20 |
14 |
$2K |
| D2332 |
|
14 |
12 |
$1K |